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Fewer Episodes (fewer + episode)
Selected AbstractsStatins may reduce episodes of exacerbation and the requirement for intubation in patients with COPD: evidence from a retrospective cohort studyINTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 9 2008A. I. Blamoun Summary Introduction:, Statins have diverse anti-inflammatory effects in addition to their lipid-lowering ability. This study assesses the rate of chronic obstructive pulmonary disease (COPD) exacerbation and intubations in patients taking statins. Methods:, This is a retrospective cohort study of 185 patients with COPD exacerbation, with a 1-year follow-up. Outcomes examined were repeat hospitalisation and intubations for COPD exacerbation. Baseline characteristics for which the p-value was , 0.10 were considered as covariates for inclusion in a multivariate model. Results:, The statin group had fewer episodes of exacerbation and required intubation fewer times than the subjects not receiving statins (p < 0.0001 for both outcomes). Unadjusted odds ratios (OR) for no statin use vs. statin use were 9.54 (95% CI: 4.54,20.02) for exacerbation and 10.47 (CI: 4.56,24.01) for intubation. The OR, adjusted for the use of angiotensin-converting enzyme inhibitors or angiotensin receptor blockers (ORa), were 2.35 (CI: 1.01,5.50) for non-statin users exhibiting an exacerbation and 10.36 (CI: 2.77,38.76) for this group requiring intubation, compared with statin users. Similarly, ORa for long-acting ,2 agonists as a covariate were 3.01 (CI: 1.46,6.10) for exacerbation and 8.89 (CI: 3.67,21.32) for intubation. Time to outcome during the observation period was reduced by statins with the hazard ratio (HR) for exacerbation of 0.19 (CI: 0.06,0.14); HR for statins reducing intubation was 0.14 (95% CI: 0.10,0.30). Conclusions:, These data suggest that the use of statins may be associated with lower incidence of both exacerbations and intubations in patients with COPD. [source] Clinical Course and Implantable Cardioverter Defibrillator Therapy in Postinfarction Women with Severe Left Ventricular DysfunctionJOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 12 2005Ph.D. , WOJCIECH ZAREBA M.D. Background: There are limited data regarding implantable cardioverter defibrillator (ICD) therapy in postinfarction women with severe left ventricular dysfunction. The aim of this study was to evaluate the risk of cardiac events and effects of ICD therapy in women as compared to men enrolled in the Multicenter Automatic Defibrillator Implantation Trial II (MADIT II). Methods and Results: Among 1,232 patients enrolled in MADIT II, there were 192 (16%) women and 1,040 (84%) men. When compared to men, women had an increased frequency of NYHA class ,II (70 vs 63%; P = 0.067), hypertension (60% vs 52%; P = 0.047), diabetes (42% vs 34%; P = 0.027), and LBBB (25% vs 17%; P = 0.011), and less frequent CABG surgery (42% vs 60%; P < 0.001). The 2-year cumulative mortality in patients randomized to conventional therapy was not significantly different in women and men (30% and 20%, respectively; P = 0.19). Adjusting for relevant clinical covariates, the hazard ratios for ICD effectiveness were similar in women (0.57; 95% CI = 0.28,1.18; P = 0.132) and men (0.66; 95% CI = 0.48,0.91; P = 0.011). The risk of appropriate ICD therapy for VT/VF was lower in women than in men (hazard ratio = 0.60 for female vs male gender; 95% CI = 0.37,0.98; P = 0.039). Conclusions: MADIT II women had similar mortality and similar ICD effectiveness when compared to men. MADIT II women with ICDs had a lower risk of arrhythmic events with fewer episodes of ventricular tachycardia than men. [source] Update on the Management of Hypertension: Recent Clinical Trials and the JNC 7JOURNAL OF CLINICAL HYPERTENSION, Issue 2004Marvin Moser MD Editor in Chief The following issues are highlighted: Emphasis is placed on the importance of systolic blood pressure elevations in estimating risk and in determining prognosis. A review of placebo-controlled clinical trials indicates that cardiovascular events are statistically significantly reduced with diuretic- or , blocker-based treatment regimens. The question of whether blood pressure lowering alone or specific medications make the difference in outcome is discussed. Based on the results of numerous trials, it is apparent that blood pressure lowering itself is probably of greater importance in reducing cardiovascular events than the specific medication used. Meta-analyses suggest, however, that the use of an agent that blocks the renin-angiotensin aldosterone system is probably more effective in diabetics and in patients with nephropathy than a regimen based on calcium channel blocker therapy. The Antihypertensive and Lipid-Lowering treatment to Prevent Heart Attack Trial (ALLHAT) reported no overall difference in coronary heart disease outcome among patients treated with a diuretic-based compared to a calcium channel blocker- or an angiotensin-converting enzyme inhibitor-based treatment program. However, patients in the diuretic group experienced fewer episodes of heart failure than in the calcium channel blocker group and fewer episodes of heart failure and strokes than those in the angiotensin-converting enzyme inhibitor group. Results were similar in diabetics and nondiabetics. Possible reasons for this outcome are discussed. The Australian National Blood Pressure 2 study, which was unblinded, reported a marginally significantly better outcome only in male patients receiving an angiotensin-converting enzyme inhibitor-based regimen compared to those receiving a diuretic-based program. Finally, the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) is reviewed. Highlights of this report include the new designation of prehypertension, i.e., blood pressures of 120,139 mm Hg/80,89 mm Hg. The JNC 7 suggested that diuretics should be the first-step drug of choice in most patients, but listed numerous specific reasons why other agents should be used in special situations. The report stressed that the majority of patients will require two or more medications to achieve goal blood pressure. [source] The role of antenatal pelvic floor muscle exercises in prevention of postpartum stress incontinence: a randomised controlled trialJOURNAL OF CLINICAL NURSING, Issue 19-20 2010Linda Mason Aim., This article reports a randomised controlled trial to determine the efficacy of antenatal pelvic floor muscle exercises in the primary prevention of postpartum stress incontinence in primiparous women. Background., Pelvic floor muscle exercises are effective in treating stress incontinence, yet prevention studies demonstrate equivocal findings. Design., Randomised controlled trial. Method., Pregnant women recruited from two hospitals in North-west England were randomised to an intervention (n = 141) or control group (n = 145). Data were collected from 2005,2006. The intervention comprised four sessions of taught pelvic floor muscle exercise training during pregnancy and 8,12 maximal contractions repeated twice daily at home. A modified Bristol Female Lower Urinary Tract Symptom questionnaire, Leicester Impact Scale and Three Day Diary were administered at 20 and 36 weeks of pregnancy and three months postpartum. Results., The intervention group was more likely to exercise their pelvic floor muscles compared to controls at 36 weeks (p = 0·019) and three months (0·022), reporting fewer episodes of incontinence and a lower score on the Leicester Impact Scale. However, these differences were not statistically significant. Conclusion., Significant differences were not demonstrated between the groups in relation to incontinence episodes and degree of bother of symptoms postpartum, although trends indicate a positive effect. Further research is necessary to address issues of adherence and the effect of pelvic floor muscle exercise undertaken during pregnancy on postpartum stress urinary incontinence. Relevance to clinical practice., A proportion of women did not meet the required attendance at antenatal class, furthermore, few exercised their pelvic floor muscles during pregnancy according to instructions. Health professionals need to find ways to instruct and motivate women to perform pelvic floor muscles exercises regularly during pregnancy and the postpartum. [source] Antibiotic prophylaxis prior to endoscopic retrograde cholangiopancreatography in patients with obstructive jaundice: is it worth the cost?ALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 4 2002B. F. Thompson Background: There are few published data concerning the economic impact of antibiotic prophylaxis prior to endoscopic retrograde cholangiopancreatography in the setting of biliary obstruction. Aim: To perform decision analysis to determine the costs of prophylaxis in patients undergoing endoscopic retrograde cholangiopancreatography for obstructive jaundice. Methods: A decision analysis model was constructed. The probability of biliary sepsis, death and endoscopic retrograde cholangiopancreatography complications was obtained from the medical literature and from a retrospective analysis of our own experience. Costs were obtained from Medicare reimbursement at our institution. The strategies evaluated were endoscopic retrograde cholangiopancreatography with and without single-dose antibiotic prophylaxis. We compared the total costs, number of episodes of cholangitis and deaths associated with each strategy. Results: Based on published data and the results of our retrospective analysis, the strategy of administering single-dose prophylactic antibiotics prior to endoscopic retrograde cholangiopancreatography in patients with obstructive jaundice resulted in lower total costs, fewer episodes of cholangitis and fewer deaths compared to a strategy of not administering antibiotics. The results were sensitive to the rates of cholangitis, cost of antibiotics and the cost of treating an episode of cholangitis. Conclusions: Antibiotic prophylaxis prior to endoscopic retrograde cholangiopancreatography results in fewer cases of cholangitis and is cost saving when compared to a strategy of no prophylaxis in patients with obstructive jaundice. [source] Episodes of hypoxemia during synchronized intermittent mandatory ventilation in ventilator-dependent very low birth weight infantsPEDIATRIC PULMONOLOGY, Issue 1 2005Steve R.E. Firme MD Abstract Distinct patterns of asynchrony, and episodes of hypoxemia, may occur in a spontaneously breathing preterm infant during conventional intermittent mandatory ventilation (IMV) on traditional time-cycled, pressure-limited ventilators. Synchronized IMV (SIMV) and assist/control ventilation are frequent modes of patient-triggered ventilation used with infant ventilators. The objective of this study was to use computerized pulse oximetry to quantify the occurrence of episodes of hypoxemia (oxygen desaturation) during SIMV vs. IMV, in preterm infants ,1,250 g who required mechanical ventilation at ,14 days of age. We performed a randomized, crossover study with each infant being randomized to IMV or SIMV (Infant Star ventilator) for initial testing for a 1-hr period. Patients were subsequently tested on the alternate modality after a stabilization period of 10 min at the same ventilator and fractional inspired oxygen concentration (FiO2) settings. Pulse oximetry data were obtained with a Nellcor N-200 monitor, a microcomputer, and a software program (SatMaster). An investigator blinded to the randomized assignment evaluated all measurements. Eighteen very low birth weight (VLBW) infants with a birth weight of 777,±,39 g (mean,±,SEM) and gestational age 25.1,±,0.3 weeks were studied. The average pulse oximeter oxygen saturation (SaO2) was higher on SIMV than IMV (P,<,0.01). During SIMV, these infants had significantly fewer episodes of hypoxemia (duration of episodes of oxygen desaturation as a percentage of scorable recording time) to 86,90% SaO2 (P,<,0.01), 81,85% SaO2 (P,<,0.01), and 76,80% SaO2 (P,<,0.05) when compared to IMV. There was also a significant decrease in percentage of time of desaturation to SaO2,<,90% (P,=,0.002),,<,85% SaO2 (P,=,0.003), and <80% SaO2 (P,=,0.02) during SIMV vs. IMV. Our preliminary findings indicate that the use of SIMV in a population of VLBW ventilator-dependent infants (,14 days of age) results in better oxygenation and decreased episodes of hypoxemia as compared to IMV. © 2005 Wiley-Liss, Inc. [source] Comorbidity of obsessive-compulsive disorder in recovered inpatients with bipolar disorderBIPOLAR DISORDERS, Issue 1 2000Stephanie Krüger Objective: To determine the frequency of obsessive-compulsive disorder (OCD) in inpatient subjects with bipolar disorder (BD) and to examine the clinical characteristics of BD subjects with OCD. Method: The sample consisted of 143 inpatient subjects with DSM-III-R BD-I and BD-NOS (BD-II), recovered from a current episode of either depression or mania. Demographic and clinical variables were obtained on the day of admission. Current comorbid conditions including OCD were determined by the Structured Clinical Interview for DSM-III-R following recovery from the acute affective episode. Results: The frequency of current OCD was 7% (N=10). All BD subjects with OCD were BD-II, were male, and had a diagnosis of current dysthymia. They had fewer episodes and a higher incidence of prior suicide attempts than bipolar subjects without OCD. None of the bipolar subjects with OCD fulfilled criteria for cyclothymia. Conclusions: Our findings suggest that BD-II, OCD, dysthymia, and suicidality cluster together in some subjects with BD. We discuss the clinical implications of our findings. [source] | ||||||||||